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Biomedical subjects

B Blettery

Publications and source records attributed to B Blettery.

14 recordsLinked to original sources
PubMed1992

Risk factors for septic shock in the early management of bacteremia.

PURPOSE: Aggressive treatment of bacteremia in patients at high risk of septic shock may prove to be beneficial and cost-effective since these patients account for 50% of the mortality. The purpose of this study was to identify risk factors for septic shock in bacteremic patients. PATIENTS AND METHODS: We retrospectively collected clinical, biologic, and radiologic data from medical records of patients who experienced one episode of bacteremia between March 1 and December 31, 1990, at the University Hospital of Dijon, France. Statistical analysis was univariate and multivariate (logistic regression). RESULTS: During the survey, 331 patients experienced one episode of bacteremia. Bacteremia due to gram-negative species was more frequently found in surgical units. Septic shocks were equally attributed to gram-negative and gram-positive bacteria. The do-not-resuscitate order was associated with nearly half of the deaths secondary to underlying diseases or poor general condition. Neither hospital-acquired bacteremia nor underlying diseases were associated with a high risk of septic shock. Multivariate analysis showed the following to be risk factors for septic shock: male gender and age older than 75 years (odds ratio = 2.91), creatinine level greater than 20 mg/L (odds ratio = 4.52), prothrombin time less than 60% (odds ratio = 4.86), and presence of an interstitial pattern on the chest radiograph involving more than half of both lung fields (odds ratio = 4.1). Our logistic model with these selected parameters allowed an overall classification of 77% of the studied patients, with a positive predictive value of 55% and a negative predictive value of 89%. CONCLUSION: Our results provide a positive predictive value that is similar to that of the clinical scores of severity proposed by other authors in selected populations. Our classification, in conjunction with a clinical classification, would allow improvement in the prognosis of patients with bacteremia by early treatment of those at high risk for developing septic shock. Validation of these results with further studies involving a larger population that includes patients with suspected infections, as well as bacteremic patients, is needed.

Adolescent↗
PubMed1992

[Multiple cerebral embolism in acute alcoholic intoxication. A pathological case].

A 37 year-old man sustained 2 ischemic strokes during acute alcohol intoxication. One month after the onset of strokes, a spontaneous atrial flutter occurred. Autopsy revealed an embolic rostral occlusion of the basilar artery. Cardiac verification did not show myocardiopathy or coronary disease. The relations between acute alcoholic intoxication and paroxystic cardiac rhythm disorders are discussed.

Adult↗
PubMed1991

[Spontaneous intracerebral hemorrhages in young patients. Study of 33 cases].

We report 33 cases of intracerebral hemorrhage (ICH) in patients aged from to 9/44 years (male: 20, female: 13, mean age: 32.5 years). ICH was due to vascular malformations in 39 p. 100 of cases, to arterial hypertension in 30% and to various causes in 18% no cause could be found in 13% of the cases. ICH was lobar in 64%, deep in 33% and infratentorial in 3% of the cases. The diagnosis was assessed by arteriography in 9 patients. The vascular malformations were arterial angiomas, saccular aneurysms and cavernous angiomas. Death rate was 24%. There was a fast ICH handicap in 40% of cases. Only 36% of the patients were not disabled.

Cerebral Hemorrhage↗
PubMed1990

[Value of sphenoidal electrodes in the EEG diagnosis of herpes encephalitis].

EEG features in acute necrotizing encephalitis show periodic activity, localized in the temporal area with a slow background activity. Nevertheless, this periodic activity is transient and may lack. Sphenoidal electrodes study of the internal face of the temporal lobe could record such activity in herpes encephalitis. Sphenoidal electrodes were inserted in 4 patients known to have herpes encephalitis. In 2 cases, periodic discharges were observed both on the surface and sphenoidal electrodes, while in 2 cases, periodic discharge was observed under only sphenoidal electrodes. Faced with uncertain diagnosis of herpes encephalitis, it may be useful to insert sphenoidal electrodes to record deep periodic discharges, not seen on surface electrodes, in order to confirm the diagnosis.

Adult↗
PubMed1989

["Malaise" at an emergency department. Diagnostic approach].

From a prospective study of 152 patients admitted to an emergency department on account of "malaise" (i.e. dizziness with or without syncope), the authors have extracted a number of interesting points. After 24 hours under observation with questioning, physical examination and measurement of blood alcohol, glucose and carbon dioxide levels, the cause of the "malaise" could be determined in 84 per cent of the patients. Among 37 patients who were detained for more than 24 hours, only 3 additional diagnoses were made. Patients with syncope had the same cause of dizziness as those without syncope. One hundred and nineteen patients were followed up for one year. The mortality rate in patients with a cardiovascular cause of "malaise" was significantly higher than in patients with other causes. Patients with dizziness of unknown origin had the same mortality rate. Patients of more than 70 years of age had a mortality rate (50 per cent) significantly higher than that of patients aged less than 70 (25 per cent). Finally, the patient's history and physical examination proved to be the most helpful aids in establishing the cause of the "malaise".

Adolescent↗
PubMed1979

[Modification of septicaemias in an intensive care unit following the suppression of prophylactic antibiotics (author's transl)].

The authors after to have suppressed the preventive antibiotic therapy in their intensive care concluded after four years of this new attitude. They ascertain that this new attitude has not changed by no means the number of septicenia in their intensive care. In the other hand, the gram negative septicemia stronghly decrease, succeeding by gram positive septicemia. This results were statistically significant in the sector of intensive care where the supress of antibiotic was quick and the most completely. Thanks to this attitude, the cost of operation of the service was divided by three.

Adolescent↗
PubMed1979

[Neurological toxicity of colistine methane sulfonate, about a case (author's transl)].

The authors report a case to call attention on a Neurological Accident happening in a patient with normal renal functions, after administration of a single and strong dose of Colistine. The authors report their case and make a review of the literature on the frequency of these isolated neurological (accidents) and their supposed (pathogenesis).

Adolescent↗
PubMed1979

[Septicaemias observed in intensive care. Causes (author's transl)].

For four years, the authors have been making researches to know how can happen cases of septicaemias observed in intensive care. They have noticed the frequency of staphylococci in septicaemias caused by catheters and of gram -- in septicaemias caused by urinary infection. From those observations, they have come to some practical conclusions. They worry about the high number of secondary septicaemia having their origin in little resuscitation operations.

Critical Care↗
PubMed1977

[Pulmonary edema due to peroperative overload or anesthetic awakening].

This report gives details of the clinical characteristics, the circumstances of onset and the treatment. There is always a blood volume overload, but the absolute value does not differ radically from that often necessary to maintain during heavy or hemorrhagic surgery, good hemodynamic conditions. The association with other factors seems necessary, in particular the redistribution in blood volum which occurs during awakening or reduction in anesthesia. Treatment by reduction in blood volume (bleeding, diuretics) is often insufficient. Many cases require mechanical ventilation for several days. Ventilation under continuous positive pressure may even be essential. The frequency of these accidents may even rise for several reasons: vasoplegic anesthesia, routine restoration of blood volume for hemodynamic reasons or to protect the kidneys, occasional failure of C.V.P. as means of control of this restoration, wider and wider use of red cells concentrates and colloids without precise knowledge of their properties.

Adult↗